post ablation and sinus tachycardia

Hello,

I am a 23 year old female and 3 months ago I had an ablation procedure done for PVC's, RVOT VT and AV nodal Re-entry tachycardia.  The procedure was considered successful for all of those arrhythmias.  Just last week, I had a follow up holter which stated:  

An average heart rate of 92bpm.  The patient's rhythm included 5hours and 9min of sinus tachycardia.  The fastest single episode of tachycardia lasted 31 minutes with a maximum heart rate of 195 bpm while the patient was at rest (reading for leisure).  Ventricular ectopic activity consisted of 3 beats.  Supraventricular ectopic activity consisted of 5 beats of which 1 was late beat, 4 were single PACs.  The longest R-R interval was 1.2 seconds.  The longest N-N interval was 1.2 seconds.  

1. I was asymptomatic  when i was being monitored. Is the sinus tachycardia something i need to monitor over time or be concerned about?

2. Is sinus tachycardia a common finding for people post ablation? Could my previous arrythmias have masked the sinus tachycardia?

3.  I now have had 4 different arrhythmias documented (3 of which have been ablated), why would one have so many different arrhythmias?  All other tests have come back within normal limits except for an MRI which showed small aneurysms on the RV freewall (which MRI specialists have said are normal variants).

4. Does my cardiac history put me at an increased risk for further cardiac problems down the line?

I do have an appointment with my EP doctor next month in which I'm sure he will discuss this with me, but I am just looking for some information before that.  

[Michael J. McWilliams, M.D.]

1.  I would need to see the strips.  That is pretty fast for sinus tachycardia, especially if you are at rest.  It might be an atrial tachycardia from near the sinus node rather than sinus tachycardia.

2 and 3.  Not that fast.  Sinus tachycardia at rest at a rate of 190 is pretty fast.  More investigation needs to be done to figure out why your heart rate was going that fast.  If you have PVCs, RVOT VT, and AVNRT, you might just have easily excitable heart tissue.  I have seen a few people like this where if you ablate one tachycardia, another pops up in another location.

4. Not necessarily, but as far as I know this has not been directly studied and would be very difficult to study directly.

I hope this helps.